Individual
MR. THEODORE HARRISON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3020 SILVER CHARM CIR, SUFFOLK, VA 23435-3343
(757) 375-5017
Mailing address
3020 SILVER CHARM CIR, SUFFOLK, VA 23435-3343
(757) 375-5017
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/11/2007
Last updated
10/11/2007
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